True beauty begins with the skin

A FIRST consultation with me can sometimes be rather frustrating for my patients. Many a time, patients come into the clinic with very specific requests: "I want to get rid of these wrinkles", "my nose is too flat", "I want a facelift", "I want higher cheekbones", "I want my chin to be a bit sharper".

My first question in response to most patients would be: "What about your skin? Do you think your skin could be better?" This question is usually met with some resistance from the patients initially, but for those who engage me on this, and fortunately this is most patients, we usually arrive at very satisfying outcomes.

We all know that the skin is the biggest organ in our body. We know that the skin is subject to all types of physical and environmental abuse on a daily basis. We all know it needs to be taken care of, and yet, most of us know so little about how to take care of it. Many of my patients spend thousands of dollars on skincare products from famous cosmetic brands, very often hopping from one brand to another if they find the results unsatisfactory, or if they get a recommendation from a friend to try another product.

Our obsession with skin health is a very primitive one, simply because the health of our skin is closely related to our general health, and thus, in more primitive terms, equates to survivability and good genes for reproduction. Most systemic diseases - diabetes, liver and kidney disease, autoimmune disease, just to name a few, have well-documented skin manifestations. Ladies' make-up - trying to create glowing skin and rosy cheeks, attempts to recreate the effects of oestrogen on the skin during ovulation, thus creating the impression of virility. Humans are naturally tuned to look at skin health, and that is why true beauty, like the canvas of a painting, begins with the skin.

Common concerns that I see in my practice include the 3 Ps of pores, pigmentation and pimples. There are also a group of patients who just have problems arriving at a balance for their skin; either too dry, too oily, or too sensitive. These problems often result in the skin looking far from ideal, and in some patients, causes problems with confidence and self-esteem.

Before I talk to patients about treatments, I usually explore extensively their skincare regime with them.

Skincare

A common issue that surfaces, when I discuss skincare with patients, is that most people do not know what each individual step in their skincare regime does for them. Most patients can recite the basic steps of Cleanse, Tone, Moisturise and Sunscreen to me when prompted, but when confronted with the fancy names of their skincare products, cannot tell me what each product is for (except of course the obvious ones like cleanser and sunscreen).

Skincare does not, and should not, have to be complicated. The growth of the aesthetic medicine industry in the last 15 years has meant that more people are asking their doctors how to maintain their skin health. Away from the catchy names and beautiful packaging of big name cosmetic brands, doctors generally adopt a very scientific and target-driven approach to skincare.

In essence, every product that you apply on your face has to serve a particular purpose and play a specific role in your overall skin health. Forging a common understanding with the patients on their skincare regime is the key to glowing, healthy skin.

My basic facial skincare checklist prescribed to the average patient with normal skin would consist of "C.R.E.A.M.S." - Cleanser and Toner, Retinoid, Exfoliator, Antioxidant, Moisturiser, and last but not least, Sunscreen. Of course, depending on the individual skin condition, certain products may need to be omitted or changed to a different product but in general every product that they use should fall into this general framework, to achieve balance and good skin health. Certain patients may also want treatment for blemishes, marks or pigmentation, and that may require additional products. A good rule of thumb to follow when exploring skincare products would be to only change one product at a time, and to make sure that the new product you use fulfils the same function as the one replaced.

Treatments for skin quality

Certainly, by the time many patients show up at the doctor's clinic, they also do want to explore some treatments that can help with improving their overall skin quality. As the number of options continues to increase, it is important that patients have a detailed consultation and discussion with their doctors before embarking on any treatment.

Lasers have been used by doctors to treat skin conditions for many years. These range from pigment lasers to improve skin tone and treat discolouration, fractional lasers to treat scarring and open pores, and more newer lasers which help to improve redness of the skin, or to help with acne control. These treatments have become increasingly common and sought after. Lasers are generally safe and efficacious, but it is important to not be overzealous with them, especially for Asian skin types, where the propensity to develop complications such as hyper and hypo-pigmentation is significantly higher than in lighter Caucasian skin types.

2018 has been an exciting year in Singapore for treatments for skin quality, with the launch of new injectable products that have shown tremendous promise in improving skin quality.

The first of these products is a Polydeoxyribonucleotide (PDRN) and Polynucleotide (PN) formulation (Rejuran). These are DNA fragments derived from salmon which are highly bio-compatible. When injected into the deep dermis of the skin, it has been shown to increase collagen remodelling and skin healing, therefore improving skin elasticity and reducing water loss through evaporation. Many other uses of PDRN are being studied as we speak, with doctors exploring it as an option for healing of stubborn wounds, scarring, as well as treatment of joint ailments and complex pain syndromes.

Skin hydration treatments have been around for a few years. These treatments harness the water-attracting properties of hyaluronic acid fillers injected into the skin to provide hydration and improved skin elasticity and glow. These "skin-booster" treatments do achieve their desired effects, but the main criticism of these treatments is that the effects can be rather short-lived for the downtime that patients have to experience. Fortunately, a promising new hyaluronic acid product (Juvederm Volite) was launched this year, which has been shown to provide longer lasting hydration (up to nine months) compared to traditional hyaluronic acid products used for skin hydration.

Skin first and foremost

I have a patient, Miss R, who first saw me three years back. She initially asked me for a filler to improve her chin contour. She had gotten a nose job and double eyelid surgery with two separate plastic surgeons in Korea in the two years before she saw me, but she said she was still unhappy with how she looked. Her lack of confidence in her looks was such that she had never taken a picture of herself prior to undergoing plastic surgery, and even after the initial euphoria of the surgical results, still had serious confidence issues with her looks.

When I examined her, I found that she had good features and bone structure. The surgeons had done beautiful work for her nose and eyelids, but she had deep acne scars and pigmentation on her face, combined with chronically dry and tired looking skin.

When asked, Miss R believed that skin issues could be easily covered up with make-up. I challenged this belief and we realised that she really hated how she looked when she first woke up in the morning and also in the evening - times of the day when she is not wearing make-up. With some convincing, we embarked on changing her skincare regime, coupled with a few sessions of laser to treat her acne scarring and to improve her overall skin tone. Miss R now leaves the house for work without wearing make-up, and is confident enough in her own looks to enrol for one of the Mrs Singapore pageants this year.

We never talked about her chin since.

This series is produced on alternate Saturdays and Sundays in collaboration with The Aesthetics Medical Clinic